GI Flashcards
- intermittent watery diarrhea, abdominal distension, anorexia, afebrile
- h/o drinking bad water on camping trip or attending daycare
- Dx: ELISA
- Tx: metronidazole
Girardia Lamlia
- absence of air in the RLQ
- finding suggestive of appendicitis
Sentinel loop
- renal failure
- thrombocytopenia
- hemolytic anemia
HUS
- green malodorous stools 2d after a picnic
- osteomyelitis in a SickleCell pt
Salmonella
- fever, HA, abd pain, muscle aches, and Rose spots
- Tx: CTX & Cefotaxime
Typhoid fever
- onset of illness several days after ingestion
- watery diarrhea & fever –> bloody diarrhea
- bandemia in absence of incr WBC
- seizures
- Tx: Bactrim
Shigella (shake-ella)
-produces vasoactive intestinal peptides that can cause diarrhea
Neuroblastoma
- due to fruit juices and excessive water intake
- MC cause of chronic diarrhea up to age 3
- formed stool in am becoming progressively looser
- growth and development are normal
Toddler’s Diarrhea
-PLE–>hypoproteinemia, steatorrhea, hypogammaglobulinemia, lymphedema, and lymphopenia
Intestinal lymphangectasia
- non bilious emesis in a neonate
- manifests within the first 6 months
- h/o polyhydramnios & LBW
- Dx: US
- Tx: surgical
- radiolucent filling defect in the pre pyloric region
antral web
- MC in males than females
- progressive non-bilious vomiting
- MC 1 month after birth (up to 5 mos)
- Dx: US showing hypertrophied pylorus
- Tx: surgical
- hypochloremic metabolic acidosis
Pyloric stenosis
- bilious vomiting the first day of life
- icteric (diminished enterohepatic circulation)
- double bubble sign
Duodenal atresia
-bilious vomiting, abdominal pain, distension, passing blood via rectum
Malrotation
- infant with bilious vomiting, R sided abd distension
- Xray: gastric and duodenal dilatation, decr intestinal air & corkscrew appearance of the duodenum
Volvulus
-dystonic movements of the head and neck along with GER
Sandifer syndrome
- early schoolage child with episodes of vomiting separated by asymptomatic periods
- emotional overtones, at risk for migraines & IBS
Cyclic vomiting
- frequent regurgitation of ingested food into the mouth, then rechewed & swallowed or spit out
- appear calm during episodes
- seen in infants of severely disturbed moms
- induce vomiting to seek attention
- Tx: resolving the emotional trigger
Rumination
-forceful vomiting, wt loss, dysphagia, FTT
Achalasia
- cyst in the floor of the mouth
- Tx: excision
Ranula
- underdeveloped or absent teeth
- Dx: skin Bx where no sweat pores are noted
- X-linked
- absence of sweat glands
Ectodermal hypoplasia
-underdeveloped small teeth
Hallermann Streiff Syndrome
- bright red bloody or tarry stools, hematemesis
- liver disease–>portal HTN
Esophageal Varices
- present with coughing with feeding in the newborn period
- Xray: feeding tube coiled up in the esophagus
- MC: upper esophageal pouch
- copious oral secretions, polyhydramnios, coughing and cyanosis with feeding, inability to pass an NG
- Tx: NPO & drain the blind pouch
TE fistula
- gastrin secreting tumor
- Sx: related to PUD
- Dx: fasting gastrin levels
Zollinger Ellison Syndrome
- bulky, pale, frothy, and foul smelling stools
- proximal muscle wasting, abd dist
- gluten sensitive enteropathy
- Dx: Bx, antigliadin or anti endomysial Ab
Celiac Disease
- worse diarrhea in the am
- emotional component
- high fiber diet & attn to emotional factors
Irritable Bowel Syndrome
- associated with small bowel resection, parasites, or IBD
- w/u: CBC
B12 deficiency and pernicious anemia
-malabsorption, hyponatremia, rectal prolapse, meconium plug, fat soluble vitamin deficiency
GI manifestations of CF
- extra teeth, polyps in the large and small intestine (pre-malignant), osteomas
- Autosomal dominant
- Tx: surgical
Gardner Syndrome
- mucosal pigmentation of lips and gums + polyps
- Tx: polypectomy
Peutz-Jeghers Syndrome
- teen with crampy lower abdominal pain w/wo bloody stools
- fever, hypoalbuminemia, anemia
- Ashkenazi Jews are at risk
- associate with HLA B27 and ankylosing spondylitis
- Tx: 5-ASA, steroids, MTX, cyclosporine
- arthritis, mucocutaneous lesions, liver disease
Ulcerative Colitis
- wt loss, incr ESR
- skip lesions, cobblestoning on EGD, transmural lesions, non-caseating granulomas
- pyoderma gangrenosum, erythema nodosum, ankylosing spondylitis, arthritis, uveitis, liver disease, renal stones
- Tx: steroids, 5-ASA
- aphthous ulcers, perianal fistulas
Crohn Disease
- sudden onset severe intermittent colicky abd pain with asymptomatic episodes
- drawing up legs and vomiting
- may be relieved with passage of stool
- bloody stool & sausage like mass
- Tx: air enema
Intussusception
- delayed passage of meconium as newborn
- constipation or intermittent loose stools
- Dx: rectal Bx
- Tx: surgical excision of aganglionic segment, colostomy & end to end anastamosis
Hirschprung Disease
-test for lower GI bleed to determine if blood is mom’s or baby’s
Apt test
-MC cause of lower GI bleeding in children 1-2 years of age
Anal fissure
- bloody diarrhea in a child from an Indian reservation or other rural areas in the South, Central, and SW US
- Dx: serology
- Tx: Flagyl
Entamoeba hiistolytica
- presents at age 2
- 2 types of tissue (gastric and intestinal)
- 2 feet from ileocecal valve
- 2 inches in length
- 2% of the population
- painless rectal bleeding
- Tx: surgical
Meckels Diverticulum
- incr direct bili, pale stools, hepatomegaly
- Causes: liver/parenchymal disease or anatomical/obstructive disease
- Dx: HIDA scan
- MC in newborn–>TPN
Cholestatic jaundice
- incr direct bili over 1 mo age
- Dx: US–>HIDA–>Bx
- Tx: Kasai before 2 mos age
Biliary Atresia
- intermittent incr serum bili w/ illness/stress
- simliar Hx in family members
- glucuronyl transferase deficiency
Gilbert Syndrome
- recent URI in which ASA was given
- encephalopathy, coma, incr LFTs, and ammonia
Reye Syndrome
- hepatitis, RTA, AMS
- KF rings
- Tx: Penicillamine–>aplastic anemia
- result of excess copper
Wilson Disease
- mid epigastric pain radiating to the back, rebound, and decr BS
- Dx: abd US (most specific), lipase >amylase
Pancreatitis
-jaundice, fever, palpable mass RUQ
Risks: hemolytic dz, TPN, sm intestine dz, obesity, pregnancy
-Dx: abd US
-Tx: surgical
Cholecystitis
- fecal oral transmission
- household contacts and daycare centers
- flu-like symptoms, incr LFTs, recent travel
- Dx: serum IgM–>acute disease
Hepatitis A
- either acute HBV infection or chronic
- one of the earliest indicators of acute infx
HBsAg
-previous HBV infx or positive immune response to immunization
Anti-HBsAg
-high rate of infectivity and high rate of viral replication
HBeAg
-indicates recent HBV infx (up to 6 mos after infx)
HBcAg IgM
- liver dz and cirrhosis
- incr incidence of hepatocellular carcinoma
- transmitted through blood and sex
Hepatitis C
- requires the presence of HBsAg to provide its outercoat
- chronic hepatitis or cirrhosis
Hepatitis D
- transmitted via fecal oral route
- MC in Asia, Africa, and Mexico
- exposure to contaminated water
Hepatitis E
- low pH
- high pCO2
- hypoventilation
- CNS dysfunction
- narcotics
Respiratory acidosis
- high pH
- low pCO2
- hyperventilation “blow off CO2”
- triggered by hypoxia or high altitude
- compensation thru incr bicarb resorption in kidneys
Respiratory alkalosis
- high pH
- high bicarb
- compensation by hypoventilation and holding onto CO2
metabolic alkalosis
- low pH
- low bicarb
- compensate with hyperventilation to decr CO2
Metabolic acidosis
- hypochloremic metabolic acidosis (incr pH)
- loss of HCl
- increased bicarb resorption in kidneys
- low urine Cl (kidneys retain)
- low Na
- low or nl K
- maybe hyperbili
Pyloric stenosis
Ureterostomy Small bowel fistula Extra chloride Diarrhea Carbonic anhydrase inhibitors Adrenal insufficiency Renal tubular acidosis Pancreatic fistula
normal anion gap
- distal tubule does not excrete H+
- urine: high pH >5.5
- incr calciuria
- normal bicarb (prox tubule ok)
- mimicked by spironolactone)
Distal (Type 1) RTA
- proximal tubule unable to absorb bicarb
- excessive bicarb in urine
- distal tubule still releases H+
- urine pH <5.5
- mimicked by carbonic anhydrase inhibitiors
Proximal (Type 2) RTA
- aldosterone resistance or aldosterone deficiency
- urine pH <5.5
- hyperkalemia
Type 4 RTA
Methanol Uremia DKA Paraldehyde Ingestion/INH Lactic acid Ethanol/Ethylene glycol Salicylates
Elevated anion gap metabolic acidosis
- healthy appearing infant at birth
- lethargy, poor feeding, seizures
- low WBC & plts
- elevated serum ammonia
- hypertension
- elevated anion gap
Organic acidemia (proprionic or methylmalonic acidemia)
- hyperammonemia
- NO metabolic acidosis
Urea Cycle Defects
- incr serum Osm
- dilute urine
- Tx: drink H20, DDAVP if central
- -incr Na, Cl, BUN, decr SpGr
Diabetes Insipidus
- dilute urine
- hypernatremic dehydration
- X-linked- found in males
- fails to respond to DDAVP
Nephrogenic DI
- hypernatremia
- low urine Na (kidneys hold onto Na)
GI losses–>hypoNa
- hyponatremia
- fluid retention, decr UOP
- incr urine Osm and incr urine Na
- Tx: fluid restriction, Demeclocycline (inhibits ADH secretion from kidneys)
- decr Na, Cl, BUN, incr SpGr
SIADH
- hyponatremia
- no volume depletion
- seizures from cerebral edema
- incr urine Na concentration (total body Na is nl)
Water intoxication
- low serum Na
- incr TG or plasma prot, or gluc (Nephrotic Syndrome)
- edema
- incr total body Na ***
- nl Cl, BUN, SpGr
Pseudohyponatremia
- weakness and paralysis
- constipation and ileus
- GI or renal losses
- EKG: flattened T waves or U wave, ST depression, PVCs
Hypokalemia
- Causes: renal failure, cell breakdown, excess intake, redistribution
- EKG: peaked T waves, absence of p waves, widened QRS
- Treatment: insulin and glucose, Sodium bicarb, Albuterol, Lasix, oral polystyrene, ***CaGluc
Hyperkalemia
UNa SCr/ UCr SNa
<1.5 low urine Na loss (pre renal azotemia)
>2.5 high urine Na loss
FeNa
-GI losses, given tea or water
-seizures
-poor skin turgor
-more symptomatic on presentation
-Tx: :3% saline (desired Na - measured Na) x wt x 0.6 = A
A + maintenance (3mEq/kg/day = replacement
-pontine damage
-decr Na, Cl, incr BUN, SpGr
Hyponatremic dehydration
- Cause: Na gain or water loss –> incr Na in ECF
- improper feeding
- Sx: doughy skin, high pitched cry, irritable, lethargy, seizures (remember Noah Lynch)
- Tx: assume 10% dehydration
- clinical picture is deceptively good
- risk for cerebral edema with correction
- incr Na, Cl, BUN, SpGr
Hypernatremic dehydration
- decr Na, incr Cr
- incr UOP
- Incr UNa, incr UOsm
- Tx: replace fluid and GI losses
Cerebral salt wasting
